That’s a WRAP: Student peers help each other stay well at McMaster

Evidence in Action

By Pam Gillett 

September 17, 2014

"It’s really easy to feel isolated and alone as a “Mad” student on campus. You hear professors use the
word “crazy” as a slur to mean something negative.

You need and have a legal right to access accommodations, but they can change your participation in class and mark you as different. You’re too nervous to attend campus groups or events because you legitimately fear they’ll be judgmental or because they’re inaccessible to you. You feel like no one can relate to your particular
experiences of student life (having to attend so many healthcare appointments, or deal with side effects, or being unable to get out of bed to attend class, or progressing at a different speed than your classmates).

You see all sorts of mental health awareness programming that isn’t aimed at you – because you already know you’re crazy – but at other people who don’t want to go crazy (like you), which makes craziness appear only negative. It’s hard when you’re isolated and don’t know anyone else like you.

You can find cool crazy people when you’re on a psych ward or attend a mental health outpatient program or consumer/survivor drop-in – but often the consumer/survivors you meet are older or at a different stage in life or not students, and so you still might not feel as if you have a peer group that understands your experiences. Plus, many healthcare services, especially those targeted at youth, overtly or covertly discourage patients from exchanging contact information or connecting with each other on our own outside of professionally-run therapy groups.

So then you’re still alone."

These are the powerful words of Alise deBie, a selfidentified “crazy person” and PhD student in the School of Social Work at McMaster University in Hamilton. As she suggests, post-secondary life can be overwhelming. But students are often unaware of how to access help, or are unable to access professional services in a timely way because of long wait lists or restrictions on the number of counseling sessions available to them.

A lack of support can result in students dropping courses, failing a term, losing their spot in residence and their bursaries, or worse - dropping out of postsecondary
education altogether. 

Professional services, however, are really only one element of care. Self-management and support by peers—people with lived experience of mental health issues—are important ingredients that support recovery and help maintain wellness. Alise has assumed a leadership role on campus, championing the rights of students facing these issues. She launched the Hamilton Mad Students Collective (HMSC) in 2012 to encourage students in Hamilton to meet, develop friendships, share
experiences, support one another, and be a part of a tradition of advocacy. This year she is offering more structured support by facilitating Wellness Recovery Action Plan (WRAP) self-help groups on campus. 

The research

The WRAP is an evidence-based, manualized group intervention for adults with mental illness. Listed on the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Registry of evidence-based programs and practices, it is an effective peer-to-peer program.

WRAP is rooted in the key concepts of hope, personal responsibility, education, self-advocacy, and giving and getting support. It helps participants to identify and understand their personal wellness resources or wellness ‘tools’.

Trained peer facilitators support participants in drawing on these tools to preserve wellness, reduce negative feelings, and improve quality of life. Participants gain insight from the facilitators and the peer group itself, but the underlying principle is clear: the
person who is developing the WRAP is the primary expert on his or her wellness. Each person chooses who assists and supports them, which may include health care providers, family members, friends or others.

With the help of a team of peers, Mary Ellen Copeland (author, educator, person with lived experience, and mental health recovery advocate) developed the program in 1997. The Copeland Center for Wellness and Recovery implements the training model. WRAP programs are now available throughout the United States, Canada, and many countries around the world. Although originally designed for an adult population, two Alberta high schools are experimenting with the program, training a team of student WRAP facilitators each year to lead school-based teen groups. The program has also been adapted for cultural norms, language differences, and unique cultural perspectives on mental illness.

Why WRAP on campus?

“I think the content of WRAP is really useful,” says Alise. “It helps consumer/survivors take back control over our lives and live the lives we want – which is really important to empowerment and staying well or not going more crazy than we’d like and being able to pursue our goals, like finish our school programs.”

Support groups, hosted by students trained as WRAP facilitators, may be a preferred and cost-effective way to help students on campus — including those in and out of professional care. In other environments, WRAP-trained facilitators have been proven to reduce the symptoms of mental illness, improve hopefulness, facilitate recovery from mental illness, enhance self-advocacy, and improve physical and mental health. Why not on campus?

“Students with mental health concerns have generally not been given information about our legal rights or how to self-advocate or how to build a support network,” says Alise. “We haven’t been offered opportunities to consider the many wellness perspectives and strategies we can use beyond CBT, medication, and other medical model approaches to ‘mental illness”’—like making art and having good sex and eating chocolate and talking to friends and engaging in spiritual practices and
participating in activism and celebrating Mad Pride.

WRAP opens up space for these conversations. In WRAP groups we can name the discrimination we suffer from and how it impacts our experiences of distress, school, and service access. We can find ways of recovering from and challenging discrimination. ‘Recovery‘ from the perspective of consumer/survivors is generally not on the radar of campus mental health services and WRAP offers this in an evidence-based way, which academic institutions especially are really keen on, given their particular perspectives on what counts as ‘evidence.’ Too frequently Mad knowledge and ways of knowing are excluded.”

Alise completed her WRAP Level II Facilitation Training in May as a participant in the Peer Recovery Education For Employment and Resilience (PREFER) program out of the Centre for Building a Culture of Recovery in York Region/ Toronto. Supported by the School of Graduate Studies at McMaster through a grant from the Student Proposals for Intellectual Community & Engaged Scholarship (SPICES), she facilitated her first WRAP group over the course of seven weeks this summer. The group, held at McMaster, was open to all students with lived experiences of madness/mental health concerns/psychiatric systems from any adult education or postsecondary
institution including those planning a return to school. Results were promising; students appreciated WRAP content and format, and many went on to attend other Mad Student events. 

“Some members have joined the Hamilton Mad Students Collective for a peer-based nonjudgmental social space and really like attending house parties, game nights, and other social stuff together,” says Alise. “Others really like our regular informal peer support meetings because they don’t need to register in advance, do homework, or stick to a particular topic or agenda. They can attend when they want and don’t feel ashamed if they miss a meeting because the style is drop-in as
opposed to an 8-week commitment. Many members connect over a 24/7 private online discussion board. They can access it from anywhere at any time and don’t need to meet inperson, which is especially great if you can’t leave the house or are too nervous to talk to people.

Sometimes HMSC members connect one-on-one for more private or practical support (like filling in forms or attending appointments together). It’s really important that we ensure a variety of ways for members to engage so that peer support is more accessible to Mad students.”

Consumer/survivor and peer support programming for students Alise hopes that colleges and universities will soon offer WRAP and other consumer/survivor peer
support programming to complement their traditional mental health services. Universities do value other peer programming—LGBT peers, for example—and she hopes schools will include a consumer/survivor peer support agenda with student peers who experience mental health concerns. In the meantime, she will build on the success of the Hamilton Mad Students Collective to support students. WRAP will be a new tool in her HMSC toolbox. With sustainability in mind, Alise is also working on building capacity in students to become future WRAP facilitators, HMSC peer supporters and Mad student activists. Student leaders like Alise can use a little help. 

Open Minds, Health Minds, Ontario’s Comprehensive Mental Health Strategy has prioritized campus mental health, investing $27 million dollars over three years to tackle the issue.

The investments, aimed in part at improving early identification and intervention, will help to put young people back on track when the stress of postsecondary life becomes overwhelming. It is a welcome investment. Prevention and early intervention are important elements of any wellness strategy. WRAP groups and other peer support programs offered on college and university campuses may become important elements of a more targeted strategy to support ‘mad’ student wellness throughout the post-secondary journey.

“Finally! This workshop and tool pieces together all of the other workshops, tools and resources I have read over the years—all in one place and set up for me. Wonderful idea! I am so happy that the tool is producing the results I thought it would. This is the first wellness group I have found where I don’t feel rushed, judged, or unable to fully comprehend the material or methods. It is whatever I want - and best of all allows me to say what I do not want. The fact that I am the creator of it, and the fact that the developers of this tool are also self-identified Mad folks, is a big draw for me. An even bigger draw was the amazing group of people I met and the supports I now have and will continue to develop as I become more involved in peer support groups. I am a firm believer that we all know what we want and need; we are all the best experts on ourselves. So why would we follow someone else’s plan, for our own wellness? Might as well make your own, in my opinion. I highly recommend WRAP and the HMSC to anyone and everyone.”
 —Genevieve Shanks,
 Student Participant

For more information on the Wellness Recovery Action Plan for students with mental health concerns in Hamilton or the Hamilton Mad Students Collective, please contact Alise at hamilton [dot] mad [dot] students [at] gmail [dot] com